NEUROSURGERY

Neurosurgery is rapidly developing both worldwide and in our country. The last decade of the 20th century was recognized as the “Decade of the Brain” in the USA, during which more resources were allocated for research related to neurological sciences. Genetic engineering studies are focused on extending human life and intensive research is being conducted on tumor biology. Additionally, diagnostic methods are also evolving, and technology is providing astonishing services to science. Neurosurgery has become quite fortunate in terms of both diagnostic methods and surgical tools and materials.

Our Neurosurgery department provides diagnostic and treatment services for brain tumors, brain hemorrhages, brain aneurysms, spinal tumors, pituitary tumors, gait analysis, and hernia treatments.

CT, MRI, PET, Angiography, CT Angiography, EEG, Sleep EEG, EMG, and Doppler Ultrasound examinations facilitate the diagnosis of lesions that occupy space, obstruct vessels, and cause bleeding in the nervous system.

Diseases of Interest in the Neurosurgery Department

• Brain tumors
• Brain hemorrhages
• Disc herniations of the lumbar and cervical spine
• Head traumas
• Vertebral column traumas, spinal tumors
• Peripheral nerve injuries, compressions
• Epilepsies that do not respond to medical treatment.

Brain Tumors

10% of tumors seen in the human body are composed of nervous system tissues. 80-90% of these develop within the cranium. The histological classification of tumors affecting the nervous system, as accepted by the World Health Organization, is as follows.

Neuroepithelial Origin Tumors:

• Astrocytomas
• Oligodendrogliomas
• Ependymal tumors
• Mixed gliomas
• Choroid plexus tumors
• Embryonal tumors
• Meningeal tumors
• Peripheral nerve sheath tumors
• Vascular tumors
• Germ cell tumors
• Malignant lymphomas
• Locally developed tumors
• Metastatic tumors
• Sellar region tumors (Craniopharyngioma and pituitary tumors)

Among these, Glioblastoma Multiforme, which is examined within astrocytomas, is the most common tumor and is considered the most malignant. Meningiomas, which are generally considered benign tumors, show recurrence in 15-20% of cases, which are referred to as anaplastic meningiomas. Medulloblastoma, a childhood tumor, is also examined among malignant tumors. 44% of metastatic brain tumors originate from the lungs, 10% from the breast, 7% from the kidneys, and 6% from the gastrointestinal system. The most common complaints in brain tumor cases are headaches, epileptic seizures, weakness in arms and legs, double vision, balance disorders, vomiting, irregular menstruation, and lactation from the breast. CT and MRI are performed as examinations, and treatment is surgical. Depending on the pathological diagnosis, it is decided whether to add radiotherapy, chemotherapy, or immunotherapy to the surgical intervention.

Brain Hemorrhages

Clinically, a picture is formed generally with headaches, vomiting, and changes in consciousness. After diagnosis with CT, cerebral angiography is performed on the patient, and treatment is planned. The first treatment to consider for patients with detected aneurysms is surgery. If there is a condition preventing surgery, and if the aneurysm is in a location and size that cannot be reached surgically, an endovascular intervention is planned. Early intervention in aneurysms, as conditions allow, is important in terms of preventing a second hemorrhage and vasospasm. The treatment of AVMs includes surgical, radiation, and endovascular interventions.

Disc Herniations of the Lumbar and Cervical Spine

The clinical picture arises from the herniation of the nucleus pulposus located between the vertebrae, usually towards the back side. In cervical hernias, symptoms include neck, back, shoulder, and arm pain, numbness, and weakness; in lumbar hernias, symptoms include lower back pain, leg pain, numbness in the leg, thinning, and weakness. In the acute period, rest, muscle relaxants, and pain relief treatments are applied. If the complaints do not resolve, an MRI is performed, and after a definitive diagnosis, physical therapy and, if necessary, surgical intervention are carried out.

Head Traumas

In head traumas, the patient’s neurological status and CT findings are evaluated, leading to classifications such as commotio, contusio, contrecoup, and diffuse axonal injury. Intracranial hematomas that occur after trauma include acute subdural hematoma, intracerebral hematoma, epidural hematoma, and SAH. The ideal follow-up is in centers where necessary intubation and tracheostomy can be performed to provide adequate respiratory support and monitoring for all head traumas.

Spinal Injuries

Since the spinal cord is located within the vertebral column, vertebral fractures and injuries must be taken seriously. Depending on the findings of the case, stabilization can be achieved conservatively with a corset. If necessary, decompression can be performed, followed by stabilization surgery. Rehabilitation treatment should begin immediately after the surgical process for the improvement of neurological findings. In peripheral nerve injuries, inter-fascicular anastomosis or nerve grafting may be performed if necessary.

Epilepsy

Surgical candidates are selected from patients with drug-resistant epilepsy; surgeries are performed after preliminary investigations and necessary preparations. The failure of medical treatment can stem from mistakes in genetic diagnosis and drug selection, as well as issues related to the patient and their environment. While preparing patients for surgery, the collaborative efforts of trained specialists in neurology, neurophysiology, psychiatry, radiology, and neurosurgery are crucial for surgical outcomes. Patients investigated with EEG, long-term video EEG recordings, and necessary MRI examinations, as well as those suitable for psychiatric methods, are treated surgically. However, severe chronic psychoses and intellectual disabilities are contraindications for surgery.

The most commonly performed surgical methods include:

• Removal of the lesion causing epilepsy; lesionectomy
• Amygdalohippocampectomy

Patients diagnosed with serious neurological examinations and the most advanced research methods are operated on with microsurgical and the most modern techniques, and if necessary, adequate intensive care follow-up is provided, and discharge is planned as soon as possible to expedite their return to normal life.

The brain and nervous system are the main components of the complex communication network in the human body. The brain is an organ of vital importance with complex functions that still retains its mystery. The central nervous system regulates movements, perceives sensations, and controls many functions by communicating with other parts of the body. The field of neurosurgery specializes in the diagnosis, control, and treatment of problems occurring in this complex system. Therefore, neurosurgeons play a critical role in human health.

What is Neurosurgery?

Neurosurgery is a medical discipline and surgical specialty that provides surgical and non-surgical management of disorders of the central, peripheral, and autonomic nervous systems. Intensive care, prevention, diagnosis, evaluation, treatment, and rehabilitation can be provided by neurosurgeons. Neurosurgeons can be divided into subspecialties such as pediatric, neuro-oncology, or spinal surgery. Additionally, neurosurgeons collaborate with many branches, including neurologists, psychiatrists, neuroradiologists, and basic science departments.

What are the Diseases of Neurosurgery?

Neurosurgeons play a role in the prevention, diagnosis, and treatment of brain, spine, and nerve disorders. They also treat and manage conditions affecting the status of blood vessels leading to the brain and blood flow. They can also take on post-operative rehabilitation after surgeries. Briefly, the diseases of neurosurgery can be mentioned as follows:

• Parkinson’s Disease: Parkinson’s disease is a brain disorder that causes unwanted and uncontrollable movements such as tremors, rigidity, and difficulty with balance and coordination. Symptoms often start slowly and worsen over time. As the disease progresses, individuals may experience walking and speech disorders, memory difficulties, depression, sleep disorders, and mental and behavioral changes. It is known to affect men more than women and typically appears after the age of 60.
• Multiple Sclerosis: Multiple sclerosis (MS) is the most common neurological disease that can lead to disability. It is characterized by the immune system cells mistakenly attacking the myelin, the protective sheath in the central nervous system. Symptoms usually appear between the ages of 20 and 40. Symptoms may include balance disorders, intermittent or frequent dizziness, bladder control issues, muscle weakness in the arms and legs, muscle spasms, and vision problems.
• Epilepsy: Epilepsy is a chronic, non-communicable brain disease that affects approximately 50 million people worldwide. It can develop due to brain tumors, brain trauma, trauma during birth, and genetic conditions. Symptoms may include loss of consciousness, movement difficulties, loss of sensation, and disturbances in mood and other cognitive functions.
• Brain Tumor: A brain tumor can develop from the growth of cells in or near brain tissue. Tumors that develop near the brain can be categorized as nerve tumors, pineal gland tumors, brain surface tumors, and pituitary tumors. Symptoms vary depending on the location and size of the brain tumor. However, common symptoms include frequent and severe headaches, nausea, blurred or double vision, memory, hearing, balance, and speech problems, confusion, and a feeling of fatigue.
• Spina Bifida: This condition occurs when the spine and spinal cord do not form correctly. It is known as another type of neural tube defect. Normally, the neural tube, which forms early in pregnancy, closes by the 28th day after conception. However, in babies with spina bifida, part of the neural tube does not close completely. This condition affects the spinal cord and the bones of the spine. It can lead to serious disabilities, and symptoms vary depending on whether the spinal cord and nerves are affected.
• Carpal Tunnel Syndrome: Also known as median nerve compression. This condition causes numbness, tingling, or weakness in the patient’s hand. Symptoms arise from pressure on the median nerve that runs along the arm and continues through the carpal tunnel in the wrist to the hand. The median nerve controls the movement of the thumb, index finger, middle, and ring fingers. Symptoms may include pain, numbness, burning, and tingling in the fingers.
• Hydrocephalus: This condition involves the accumulation of fluid in the ventricles of the brain. Excess fluid increases the volume of the ventricles and puts pressure on the brain. Hydrocephalus can occur at any age, but it is most commonly seen in infants and adults over 60. Surgical procedures can restore healthy levels of cerebrospinal fluid. Symptoms may include an unusually large head, swelling or tense soft tissue at the top of the head, nausea, seizures, issues with muscle tone and strength, and eyes fixed downward.
• Scoliosis: This condition involves the lateral curvature of the spine. Symptoms may include lower back pain, stiffness in the back, pain and numbness in the legs due to nerve compression, fatigue due to muscle tension, and difficulty breathing due to upper spinal curvature.
• Brain Hemorrhage: A brain hemorrhage occurs due to the rupture of an artery in the brain and the development of localized bleeding in surrounding tissues. This bleeding kills brain cells. 13% of strokes develop due to brain hemorrhage. Symptoms of brain hemorrhage may include weakness in the arms and legs, sudden onset of severe headaches, seizures, difficulty swallowing, reading, and writing. Other symptoms may include abnormal taste sensations, loss of consciousness and coordination, hand tremors, and loss of motor skills.
• Meningitis: Also known as inflammation of the brain membranes, infections can develop in the fluid and membranes surrounding the spinal cord. Infections can be caused by viral, bacterial, parasitic, and fungal agents. Symptoms may include sudden high fever, skin rash, neck stiffness, light sensitivity, and decreased appetite and thirst.
• Brain Vascular Diseases: Brain vascular diseases can occur in many vessels, including arteries, carotid arteries, and vertebral vessels. Some of these diseases can be listed as venous malformations, carotid stenosis, brain aneurysms, transient ischemic attacks, strokes, and brain hemorrhages.
• Cranial Nerve Palsies: Cranial nerves are directly outgoing nerves from the brain, head, face, and part of the body. There are 12 pairs of cranial nerves, some of which are related to special senses such as vision, smell, hearing, and taste, while others control muscles and glands. Partial weakness in areas where cranial nerves function can lead to paralysis. Cranial nerve palsies can limit eye movements and cause strabismus and double vision.

What are the Symptoms of Neurosurgery Diseases?

There are many diseases related to neurosurgery. Although symptoms vary depending on the type of disease, its location, and severity, general symptoms can be listed as follows:

• Fever,
• Severe and abnormal headaches,
• Dizziness,
• Nausea and vomiting,
• Seizures,
• Loss of consciousness,
• Balance, coordination, focus, memory, and movement disorders,
• Changes in personality, behavior, and mood,
• Speech, swallowing, and vision disorders.

How is the Diagnosis of Neurosurgery Diseases Made?

In diagnosing brain and nerve diseases, the first step is to take the patient’s history and perform a physical examination. During the physical examination, neurological findings are evaluated. Motor, sensory, reflex, and cognitive functions are assessed. Based on the data obtained from these examinations, referrals may be made for other necessary tests. Procedures that may be used for diagnosis can be listed as follows:

• Biopsy: Small tissue samples needed for laboratory analysis are taken by health professionals. The obtained tissue samples can help determine whether a brain tumor is cancerous.
• Electroencephalography (EEG): Tests the brain’s natural electrical activity and function.
• Evoked Potential Tests: Allows for the diagnosis of neurological conditions. It is a non-invasive procedure that records the brain’s electrical activity and responses to specific stimuli. It is most commonly used for diagnosing multiple sclerosis.
• Imaging Tests: Computerized tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography (PET) scans provide detailed images of the brain. This way, brain activity, diseases, or damaged areas can be detected.
• Laboratory Tests: Blood, urine, stool, or cerebrospinal fluid tests may be requested. Additionally, some genetic tests may also be beneficial during the diagnosis phase.
• Cognitive Function Tests: Allows for the assessment of memory, thinking, and problem-solving abilities.
• Neurological Examination: Changes in balance, coordination, hearing, eye movement, speech, and reflexes are evaluated.

How is the Treatment of Neurosurgery Diseases Done?

Neurosurgery diseases can be treated with many treatment procedures. The most commonly used treatment methods can be summarized as follows:

• Biopsy: After potential abnormalities are detected, a procedure is performed where an incision is made in the skull to remove brain cells or tissue using a needle.
• Craniotomy: A procedure in which a part of the skull is removed to remove a brain tumor, abnormal tissue, blood, or clots. After the surgery is completed, the skull piece is replaced.
• Craniectomy: Similar to craniotomy, in this procedure, the surgeon accesses the brain by removing a part of the skull but does not replace it during the same surgery due to concerns about pressure in the brain. The piece of skull is replaced during a second surgery called cranioplasty.
• Deep Brain Stimulation: Medical devices are implanted to provide electrical stimulation to certain areas of the brain. It is frequently used in movement disorders such as Parkinson’s disease.
• Neuroendoscopy: A minimally invasive technique. A thin tube called an endoscope is delivered to the brain tissue through the mouth, nose, or small incisions in the skull. The endoscope has a light and camera at its tip, and surgeries are performed with tools inside it. It can be used to remove brain tumors and lesions near the pituitary gland, located just behind the bridge of the nose.
• Stereotactic Radiosurgery: A non-invasive treatment option for spinal tumors. Narrow radiation beams are used to precisely target the tumor. This way, pain and tumor control can be achieved.
• Endovascular Surgery: A procedure in which a small incision is made in the patient’s groin to place a thin, flexible tube into a blood vessel. The catheter is passed to the brain without cutting the skull. There, blood clots can be cleared or aneurysms repaired.
• Laser Ablation: A procedure that uses a laser probe passed through a small hole in the skull, allowing the surgeon to remove tumor and epileptic tissue.

Frequently Asked Questions

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Neurology is a medical branch aimed at diagnosing and treating conditions affecting the nervous system, which consists of the brain, spinal cord, and nerves. Physicians specialized in the field of neurology are called neurologists. Neurologists do not perform surgery. Neurosurgeons, on the other hand, can diagnose and treat disorders of the nervous system through surgical and non-surgical procedures. Neurologists can refer patients to a neurosurgeon when surgery is deemed necessary.

The diagnosis and treatment of nerve and vascular diseases are handled by the neurology, and neurosurgery departments.

An electromyography test (EMG) may be requested to measure how well the muscles respond to nerve signals from the brain.

Neurosurgery can address many complaints, including stroke, certain types of chronic pain, head, neck, and spinal injuries, brain and spinal tumors, cerebral aneurysms, neurological disorders, and movement disorders.

Surgeries such as biopsy, decompression, endovascular surgery, deep brain stimulation, laser ablation, neuroendoscopy, craniotomy, and craniectomy can be performed.

Brain clots are addressed by neurosurgery.

Complete blood count, urine tests, stool and cerebrospinal fluid tests, biopsy, and angiography may be requested.

Electromyography (EMG) and nerve conduction studies can be performed to measure the transmission of nerve signals to the muscles. EMG measures how much electrical activity is produced by muscle contraction. Nerve conduction studies evaluate the flow of electrical current through the peripheral nerve before it reaches the muscle. These two tests are often performed together.

Symptoms such as pain, numbness, or tingling in the compression area, reduced mobility of the limb, inability to grasp or hold objects, and muscle loss may occur. Additionally, tests such as EMG and nerve conduction studies can also be performed.

Symptoms of brain hemorrhage develop suddenly and worsen over time.

The health of the brain and nervous system is extremely important, and early diagnosis of any problem is vital. If you are experiencing symptoms specific to brain and nervous system diseases, it is recommended to consult a physician. Symptoms can often develop suddenly and worsen quickly, so expert support should be sought without delay. Early diagnosis and treatment of brain and nervous system diseases can improve the quality of life.